August 8, 2011

New study looks at the role carpal tunnel syndrome patients play in medical decision-making process

Patients receiving treatment for carpal tunnel syndrome (CTS) prefer to play a more collaborative role when it comes to making decisions about their medical or surgical care, according to the findings of an August 3rd issue of the Journal of Bone and Joint Surgery (JBJS).

"While other studies have shown patients with potentially life-threatening conditions such as cancer tend to prefer a more passive role when it comes to decision-making, this study demonstrates that in carpal tunnel syndrome, which raises issues of quality of life rather than those related to a life-threatening condition, the majority of patients preferred to share decision making with their physicians," said study author and orthopaedic surgeon Hyun Sik Gong, MD, PhD.

Study Details and Findings

In this study, 78 patients who underwent carpal tunnel release for CTS were requested to indicate their preferred level of involvement preoperatively and to assess their actual levels of involvement postoperatively, using a scale containing five levels ranging from fully active to fully passive.

According to the study results, patients were more likely to assume an active role in the decision-making process if they:

* had undergone one or more previous surgical procedures; * had a caregiver; or * had additional private insurance to help defray treatment costs.

"It is likely that the experience of a previous operation clarified uncertainties or conflicts regarding surgery, and that the presence of a caregiver allowed patients greater freedom during decision-making," Dr. Gong noted.

Dr. Gong said that previous studies have described three primary approaches to medical decision-making:

* The paternalistic model, in which physicians make decisions on the basis of what they believe to be in the patients' best interest, and minimal information is conveyed from the physician to the patient; * The consumerist model, in which doctors provide the information that patients require to make their own decisions; * And the shared decision-making, or collaborative, model, in which the physician and patient make the decision together and exchange medical and other information related to the patient's health. Dr. Gong added that previous studies have shown that this type of decision making leads to greater patient satisfaction in medical or surgical treatment.

"This study shows the majority of patients wanted to share decision-making with their physicians, and patients should feel comfortable asking questions and expressing their preferences regarding care. Patient-centered care emphasizes the incorporation of individual styles of decision making to provide a more patient-centered consultation," Dr. Gong added.

In a "Ëpatient-centered' approach, patients' cultural traditions, personal preferences and values, family situations, social circumstances and lifestyles are considered in the decision-making process.

Patient-centered care presumes active involvement of patients and their families in health care and in decision-making about individual options for treatment, and is identified as one of important factors constituting high-quality health care, Dr. Gong continued.

Although the current study did not determine which type of role, if any, resulted in better surgical outcomes, Dr. Gong said a subsequent study is being conducted evaluating surgical outcomes and patients' preferred levels of involvement.

"Symptoms and signs of CTS are widely recognized, but the natural history is still unclear," Dr. Gong said. "There are several treatment options available for CTS, but a discussion between a patient and his or her physician, based upon what activities patients need to pursue will help them achieve their mutual goal of getting back to activities, together. Therefore, the need for patient involvement in CTS is different from the treatment for other orthopaedic conditions such as fractures or bone tumors, where the decision can be more straightforward or depend on the physician's decision."

Patients considering treatment of carpal tunnel syndrome or any orthopaedic injury should feel comfortable with their provider's level of involvement and not be afraid to ask questions or speak up, Dr. Gong noted.